Individual
ADAM ROBERT DZIEDZIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
3410 ILLINOIS ST, GREAT LAKES, IL 60088-3120
(224) 610-8553
Mailing address
3410 ILLINOIS ST, GREAT LAKES, IL 60088-3120
(224) 610-8553
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085004025
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085004025
STATE OF ILLINOIS
IL
Enumeration date
08/29/2006
Last updated
03/12/2024
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